Donör Hepatektomi Sırasında Pringle Manevrası Uygulamasının Donör ve Recipientte İskemi-Reperfüzyon Hasarı Gelişmesi Üzerine Etkisi
Küçük Resim Yok
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmanın amacı hem Pringle manevrası uygulanan ve uygulanmayan donörlerin remnant karaciğerlerinde hem de bu donörlerden elde edilen karaciğer greftlerinin transplante edildiği alıcılarda iskemi ve reperfüzyon hasarının klinik ve laboratuvar yansımalarını değerlendirmektir. Gereç ve Yöntem: Bu randomize çift kör araştırmaya Şubat 2021 ve Haziran 2021 tarihleri arasında donör hepatektomi yapılan 54 donör ve canlı vericili karaciğer nakli yapılan 54 alıcı olmak üzere toplam 108 hasta dahil edildi. Donörler Pringle manevrası yapılan (n=27) ve yapılmayan (n=27) olmak üzere iki gruba ayrıldı. Benzer şekilde bu donörlerden elde edilen karaciğerin implante edildiği alıcılarda Pringle manevrası yapılan (n=27) ve yapılmayan (n=27) olmak üzere iki gruba ayrıldı. Donör ve alıcılardan pre-operatif, post-operatif 0. saat, post-operatif 1. gün, post-operatif 2. gün, post-operatif 3. gün, post-operatif 4. gün, post-operatif 5. günlerde kan numuneleri ve back table sırasında greftten karaciğer dokusu alındı. Çalışmaya dahil edilen parametreler arasında rutin hemogram ve biyokimya parametrelerinin yanında, IL-1, IL-2, IL-6, TNF-? ve ?-galaktozidaz ölçümleri ve histoloji laboratuvarında alınan dokularda iskemi-reperfüzyon hasarının bulguları incelendi. Bulgular: Pringle manevrası yapılan ve yapılmayan donör grupları arasında tüm zamanlarda alınan iskemi-reperfüzyon hasarına yönelik bakılan biyokimyasal analizlerde istatistiksel olarak anlamlı farklılık bulunmadı. Benzer şekilde Pringle manevrası yapılan ve yapılmayan greftlerin implante edildiği alıcı grupları arasında da istatistiksel olarak anlamlı farklılık saptanmadı. Her iki alıcı grubu arasında perioperatif kanama (p=0,248) ve erken dönemde görülen safra yolu komplikasyonları (p=0,685) açısından da istatistiksel olarak anlamlı bir farklılık saptanmadı. Karaciğer greftinden yapılan histopatolojik incelemelerde Pringle manevrası yapılan grupta hepatosit hasarı skorlaması istatistiksel olarak anlamlılık gösterecek kadar yüksek bulunmuştur (p=0,001). Sonuçlar: Her ne kadar histolojik olarak hepatosit hasarı skorlaması Pringle manevrası yapılan grupta yüksek bulunmuş olsa da Pringle manevrasının donörlerde ve bu donörlerden elde edilen karaciğer greftinin implante edildiği alıcılarda iskemi-reperfüzyon hasarına laboratuvar ve klinik olarak negatif yansıması olmamıştır. Anahtar Kelimeler: İskemi-reperfüzyon hasarı, karaciğer nakli, Pringle manevrası
Aim: The aim of this study is to evaluate the clinical and laboratory changes of ischemia and reperfusion injury in the remnant livers of donors with and without Pringle maneuver. Furthermore, we evaluated the recipients who have been transplanted with liver grafts from these donors. Material and Method: A total of 108 patients, 54 donors who underwent donor hepatectomy and 54 recipients who underwent living donor liver transplantation, were included in this randomized double-blind study between February 2021 and June 2021. The donors were divided into two groups: Pringle maneuver applied (n=27) and Pringle maneuver not applied (n=27). Similarly, recipients with implanted liver obtained from these donors were divided into two groups as Pringle maneuver performed (n=27) and not performed (n=27). Blood samples from donors and recipients were obtained on pre-operative, post-operative 0. hour, post-operative 1st day, post-operative 2nd day, post-operative 3rd day, post-operative 4th day, post-operative 5th day and liver tissue was taken from the graft during the back table procedures. Routine tests such as hemogram and biochemical analysis, IL-1, IL-2, IL-6, TNF-?, and ?-galactosidase measurements and histopathological findings were examined. Results: There was no statistically significant difference in the parameters of biochemical analyses for ischemia-reperfusion injury at all time periods in the donors with and without Pringle maneuver. Similarly, there was no statistically significant difference between in the recipients in who received liver grafts harvested with and without Pringle maneuver. There was no statistically significant difference between the two recipient groups in terms of perioperative bleeding and early bile duct complications (p=0.685). In the histopathological examinations, hepatocyte damage was significantly higher in the Pringle maneuver group (p=0.001). Conclusion: Although the histological scoring of hepatocyte damage was found to be higher in the Pringle maneuver group, the Pringle maneuver did not have an adverse effect on ischemia-reperfusion injury in donors and recipients that was evaluated by clinical and laboratory analyses. Key Words: Ischemia-reperfusion injury, liver transplantation, Pringle maneuver
Aim: The aim of this study is to evaluate the clinical and laboratory changes of ischemia and reperfusion injury in the remnant livers of donors with and without Pringle maneuver. Furthermore, we evaluated the recipients who have been transplanted with liver grafts from these donors. Material and Method: A total of 108 patients, 54 donors who underwent donor hepatectomy and 54 recipients who underwent living donor liver transplantation, were included in this randomized double-blind study between February 2021 and June 2021. The donors were divided into two groups: Pringle maneuver applied (n=27) and Pringle maneuver not applied (n=27). Similarly, recipients with implanted liver obtained from these donors were divided into two groups as Pringle maneuver performed (n=27) and not performed (n=27). Blood samples from donors and recipients were obtained on pre-operative, post-operative 0. hour, post-operative 1st day, post-operative 2nd day, post-operative 3rd day, post-operative 4th day, post-operative 5th day and liver tissue was taken from the graft during the back table procedures. Routine tests such as hemogram and biochemical analysis, IL-1, IL-2, IL-6, TNF-?, and ?-galactosidase measurements and histopathological findings were examined. Results: There was no statistically significant difference in the parameters of biochemical analyses for ischemia-reperfusion injury at all time periods in the donors with and without Pringle maneuver. Similarly, there was no statistically significant difference between in the recipients in who received liver grafts harvested with and without Pringle maneuver. There was no statistically significant difference between the two recipient groups in terms of perioperative bleeding and early bile duct complications (p=0.685). In the histopathological examinations, hepatocyte damage was significantly higher in the Pringle maneuver group (p=0.001). Conclusion: Although the histological scoring of hepatocyte damage was found to be higher in the Pringle maneuver group, the Pringle maneuver did not have an adverse effect on ischemia-reperfusion injury in donors and recipients that was evaluated by clinical and laboratory analyses. Key Words: Ischemia-reperfusion injury, liver transplantation, Pringle maneuver
Açıklama
Anahtar Kelimeler
Genel Cerrahi, General Surgery
